Key Points about Parasomnia

  • Parasomnias are a group of sleep disorders that make it difficult to rest during the night and feel rested and productive during the day.
  • Sleep specialists diagnose sleep conditions using a physical exam, comprehensive sleep history, a sleep log and often participation in a sleep study.
  • Treatment for these sleep disorders may include a combination of medications, lifestyle modifications and therapy.

Overview

Parasomnias are a group of sleep conditions that cause unwanted or unpleasant experiences while you are falling asleep, sleeping or just waking up. These sleep conditions can cause unusual movements, behaviors, emotions, dreams or perceptions. 

Types of parasomnias include:

  • Bedwetting. When an adult fails to wake up when their bladder is full and empties the bladder in the bed, this is known as bedwetting. Bedwetting is typically caused by an underlying condition, such as stress, diabetes or a urinary tract infection (UTI).
  • Confusion arousals. People with this condition act very unusual or confused just after waking up.
  • Exploding head syndrome. People with this condition hear a loud, imaginary noise right before they fall asleep or wake up. The noise might sound like a bomb exploding or cymbals crashing and prevents the person from getting effective sleep.
  • Nightmares. People who have frequent bad dreams can suffer from disrupted sleep patterns.
  • Rapid eye movement (REM) sleep behavior disorder. People with this condition physically act out vivid dreams during sleep. This behavior may include kicking, punching or flailing in response to dreams.
  • Sleep eating disorder. People with this condition eat large quantities of food (binge eat) while partially asleep. When they wake up, they have very little to no memory of eating the food.
  • Sleep terrors. Also known as night terrors, these are dreams that cause intense fear upon waking with barely any memory of the actual dream.
  • Sleepwalking. People with this condition stand up and walk around their home while fully asleep. They have no memory of this activity upon waking.
  • Sleep paralysis. People with this condition are temporarily paralyzed (unable to move) while falling asleep or upon waking. Paralysis episodes can last seconds or minutes.
  • Sleep hallucinations. People with this condition experience imagined events that seem extremely real and can even involve your senses of touch, taste and smell.
  • Sleep talking. This condition is relatively common and typically harmless, but it may be a sign of another underlying sleep condition.

Parasomnia causes 

Causes of parasomnias include:

  • Behavioral disorders, such as attention deficit hyperactivity disorder (ADHD)
  • Certain medications
  • Depression
  • Illicit drug use
  • Irregular sleep cycle
  • Neurological disorders, such as epilepsy and Parkinson’s disease
  • Post-traumatic stress disorder (PTSD)
  • Sleep deprivation
  • Stress

Parasomnia risk factors

Factors that increase the risk of developing a parasomnia disorder are having:

  • Anxiety
  • Depression
  • Epilepsy
  • Insomnia
  • Post Traumatic Stress Disorder (PTSD)
  • Parkinson’s disease

Other factors that increase the risk of developing parasomnia include:

  • Increased, unmanaged stress
  • Not getting enough sleep
  • Taking certain medications
  • Using illicit drugs or alcohol
  • Working the night shift, or irregular shifts

Parasomnia symptoms

Signs and symptoms of parasomnia vary depending on the type of parasomnia disorder. Symptoms can include:

  • Bad memory
  • Confusion
  • Have excessive daytime sleepiness
  • Slowed or slurred speech
  • Getting out of bed and eating large quantities of food, but having no memory of doing so
  • Getting out of bed and walking around the house, but having no memory of doing so
  • Having very troublesome dreams that prevent you from getting enough sleep
  • Hearing a loud, imaginary noise just before falling asleep, or upon waking up
  • Jumping or leaping in your sleep
  • Kicking, grabbing, punching or thrashing in your sleep
  • Not being able to move before or after sleep
  • Shouting or swearing in your sleep
  • Talking in your sleep
  • Trouble sleeping through the night
  • Urinating in bed while asleep
  • Waking up from sleep with your heart racing

Parasomnia diagnosis

A specialist will use one or more of the following diagnostic tools to diagnose parasomnia:

  • Physical exam. Your specialist will complete a physical exam and ask you about your symptoms related to sleep problems. You may also need to fill out a detailed sleep history.
  • Sleep log. Your specialist may ask you to keep a detailed sleep log that includes information on when you go to bed and get up, how many times you wake up during the night and other information.
  • Polysomnogram. Your sleep specialist may ask you to spend the night in a sleep lab to undergo this type of specialized sleep test. A polysomnogram records your brain waves, breathing and heart rate during the night.

Parasomnia treatment

Treatment for parasomnia may include a combination of the following treatment options:

  • Medication. Your specialist may prescribe one or more medications – such as antidepressants, dopamine agents or melatonin – to help better regulate your nighttime sleep and reduce your parasomnia symptoms.
  • Cognitive behavioral therapy (CBT). If your sleep specialist believes your parasomnia is related to a mental health issue such as stress or anxiety, they may recommend you work with a specially trained therapist to undergo CBT.
  • Lifestyle modifications. There are certain things you can change in your daily life to help manage some symptoms of parasomnia. Try to keep consistent bedtime and wake-up times. If you move around your home during sleep, try to move hazardous items – such as kitchen knives – so they can’t be accessed easily. Deadbolt doors and lock windows to make leaving your house more difficult, if this is a concern.

When should I seek care?

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing a sleep medicine provider for more specialized treatment.